Impact of Early versus Late Initiation of Renal Replacement Therapy in Patients with acute kidney injury after liver transplantation: a retrospective study.

doi:10.21203/rs.2.17470/v1

Download PDF

Research article

Impact of Early versus Late Initiation of Renal Replacement Therapy in Patients with acute kidney injury after liver transplantation: a retrospective study.

https://doi.org/10.21203/rs.2.17470/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background: Acute kidney injury is a frequent complication after liver transplantation. RRT is an important treatment for AKI, but the optimal time for initiation of RRT is still controversial. Our aim is to investigate the prognosis effect of initial RRT treatment time.

Methods: Clinical data of 173 recipients undergoing liver transplantation from July 2017 to March 2019 was retrospectively analyzed. All the patients receiving RRT were divided into early and late group. Prognosis were compared between the two groups.

Results: 48 patients developed AKI, among which 23 cases(13.29%) received RRT, of which 13 were in early group (56.52%) and 10 were in late group (43.48%). AKI was associated with longer length of ICU and hospital stay, increased post-operative 30 and 90 day mortality, the incidence of PNF and EAD. In patients receiving RRT, compared with the early group, the duration of length of ICU and hospital stay and the incidence of severe infection were significantly increased in late group (P < 0.05).

Conclusions: AKI was associated with longer length of ICU and hospital stay, poor short-term mortality and functional recovery of transplanted organ. Early initiation of RRT could reduce the severe infection and length of ICU and hospital stay.

Urology & Nephrology

Renal replacement therapy

Acute kidney injury

liver transplantation

Acute kidney injury (AKI) is one of the main postoperative complications after liver transplantation (LT), and is associated with increased morbidity and mortality[1]. The incidence of AKI and severe AKI requiring renal replacement therapy (RRT) were 40.7% and 7.7%, respectively[1]. Post-LT AKI is associated with increased short-term mortality rate and graft dysfunction[2,3]. Post-LT AKI is caused by multifactorial origin with recipient, graft, perioperative, and postoperative factors[4]. There is increasing evidence that Increased MELD Score, diabetes mellitus, hypertension, obesity, Intraoperative blood loss and transfusion of blood products, postoperative immunosuppression therapy are risk factors[5].

In order to standardize the definition and classification of AKI, the RIFLE, AKIN and KDIGO criteria were put forward successively[6,7,8]. Although most patients eventually recover after an episode of AKI, many patients invaded their renal reserve or did not return to baseline renal function. And severe AKI requires renal replacement therapy (RRT), however, there is a lack of consensus on several aspects of RRT, especially the optimal initiation timing[9]. Indeed, despite the large amount of evidence available, it still represents an unsolved problem[10]. Especially, there is no report about the optimal initiation timing of RRT for AKI after liver transplantation.

Thus, we aim to estimate the incidence of post-LT AKI in our center and to evaluate its impact on patient outcomes. And for severe post-LT AKI patients receiving RRT treatment, We focus on the effect of the timing of initiation of RRT on prognosis.

The records of 173 patients who received LT at The First Affiliated Hospital of Sun Yat-Sen University (Guangzhou, China) from July 2017 to March 2019 were retrospectively reviewed. Immunosuppressive therapy for all patients after LT was individualized therapy, and immunosuppressive agents were adjusted based on drug blood concentrations.

Recipient data extracted from the medical records included age and gender, model of end-stage liver disease (MELD) score, HBV infection status, previous history of hypertension, diabetes mellitus (DM), previous liver disease, hepatic encephalopathy. For donors, age and gender, BMI, donor status [DCD or DBD], cold ischemia time, Pathology of donor liver, serum Na⁺ and total bilirubin. From the intraoperative period, we recorded: blood loss, volume of Blood transfusion, duration of surgery and anhepatic period. Postoperative indicators included: Urine volume, serum creatinine, primary nonfunction (PNF), early allograft dysfunction (EAD), days of ICU and overall in-hospital stay, 30 and 90 day mortality rates, as well as follow-up time.

AKI was defined according to KDIGO criteria as an increase of serum creatinine by ≥26 μmol/L within 48 h as well as an increase to ≥1.5 times baseline within 7 days[8]. They were categorized as patients with AKI or not (Table 1). We defined the initiation timing of RRT based on urine output (during the 24h prior to RRT initiation)[11], urine output criteria were defined as “early” when UO during the 24h prior to RRT was >0.05 mL/kg/h and as “late” when UO was <0.05 mL/kg/h.

Fisher’s exact test or chi-square test was used for comparisons of categorical data. Student’s t test and the Mann–Whitney U test were used for the comparisons of continuous variables, according to their distribution, as appropriate. Effects of parameters to estimate AKI were evaluated with multivariate logistic regression models.

All statistical analyses were performed using SPSS version 19.0 statistical software (SPSS, Chicago, IL, USA). Values of p < 0.05 were considered to indicate statistical significance.

All organs come from voluntary donation from citizens, no executed prisoner (even with his/her consent) was involved. The study was approved by the Ethics Committee of The First Affiliated Hospital of Sun Yat-sen University and in accordance with the Declaration of Istanbul（number 2018–091）. All protocols conformed to the ethical guidelines of the 1975 Helsinki Declaration.

Of the 173 eligible patients, 158 patients (91.33%) were men. The mean age ± SD was 50.88 ± 9.43 years. Hepatocellular carcinoma (HCC) was the most common etiologic factor(53.18%). 149 patients(86.13%) were hepatitis B positive. the median model of end-stage liver disease (MELD) score prior to LT was 14 (IQR: 9–20.75). There were 14 diabetic patients (8.09%), and 7 patients(4.05%) presented hypertension before LT(Table 2).

Among the 173 patients, 48 (27.75%) developed AKI after LT. Table 2 shows the risk factors for AKI. The following factors were AKI predictors: preoperative encephalopathy, high MELD score, intraoperative bleeding volume, Blood transfusion volume, long operation time and cold ischemia time. In the multivariate analysis, independent risk factors for AKI were: intraoperative bleeding volume (OR = 1, 95% CI = 1.000–1.001) and Plasma transfusion(OR = 1, 95% CI = 1.000–1.001) (Table 3).

AKI patients had a longer ICU stay, 85 hours (21.5–196.5) vs. 28.6 hours (15–42), p = 0.000, as well as longer overall hospital stay, 24.5 days (17–40) vs. 20 days (15–29), p = 0.003 than non AKI patients, respectively. There were 10 patients (20.83%) and 13 patients (27.08%) died within 30 days and 90 days in the AKI group, while 2 patients (1.6%) and 2 patients (1.6%) died in the non-AKI group. Early allograft dysfunction (EAD) occurred in 25 patients（52.08%）in AKI group and 27 patients（21.6%）in non-AKI group. Primary nonfunction (PNF) occurred in 8 patients（16.67%）in AKI group and 0 patients（0 %）in non-AKI group（Table 4）.

Of the 48 AKI patients, 23 received RRT treatment. According to the definition of the initial time of “early” and “late” RRT, 13 patients were divided into the early group and 10 patients into the late group（Table 5）. The 30-day mortality was 23.08% in the early group, 40% in the late group. The 90-day mortality was 30.77% in the early group, 50% in the late group. The patients in late group had a longer ICU stay, 183.5 hours (92.25–336.75) vs. 139 hours (94–240), p = 0.043, as well as longer overall hospital stay, 38.5 days (17.5–62.75) vs. 35 days (17–38), p = 0.019 than early group patients, respectively. Early allograft dysfunction (EAD) occurred in 9 patients（69.23%）in early group and 8 patients（80%）in late group. Primary nonfunction (PNF) occurred in 1 patients（7.69%）in early group and 4 patients（40%）in late group. There were 8 patients with severe infection in late group and 4 patients in early group(P = 0.026).

Liver transplantation is the most effective treatment for end-stage liver disease. AKI is a common complication following liver transplantation, which was found in 26.3%–75.6% patients, this disparity is large dependent on the definition of AKI[12,13,14]. In 2012, KDIGO revised AKI classification merged the AKIN and RIFLE criteria by including both an increase of serum creatinine by≥26 μmol/L within 48 h as well as an increase to≥1.5 times baseline within 7 days as threshold for diagnosis of AKI[8]. So far few studies have used KDIGO criteria to evaluate post-LT AKI. The present study used this KDIGO criterion to define and classify AKI, and the incidence of post-LT AKI was 27.75%.

Several risk factors for post-LT AKI have been identified in varying populations. It is likely that post-LT is of multifactorial origin with recipient, graft, perioperative and postoperative factors contributing to its development. Recipient factors included high MELD-scores, pretransplant SCr and body mass index (BMI)[15,16]. Intraoperative factors, such as inferior portal vein clamping, intraoperative blood loss and blood transfusion, cold and warm ischemia time, and operation time contributes to AKI occurrence[17]. Furthermore, perioperative hyperglycaemia has been suggested as a risk factor for AKI[18]. Risk factors for AKI in the post-transplant period included nephrotoxic drugs use, mainly calcineurin inhibitors, and hypoalbuminemia[17,19]. In our study, Logistic multivariate analysis suggested that intraoperative bleeding volume (OR = 1, 95% CI = 1.000–1.001) and Plasma transfusion(OR = 1, 95% CI = 1.000–1.001) were risk factors for AKI.

Due to the absence of effective pharmacological treatment, the treatment of AKI patients mainly depends on the management of hemodynamics and volume status, the correction of electrolyte and acid-base disturbances, the provision of adequate nutrition and the adjustment of drug doses. For less severe AKI patients, conservative treatment can be considered as the treatment option. For patients with sustained, severe renal failure, RRT can be used to treat volume overload, hyperkalemia, acidosis and symptoms of uraemia waiting for the recovery of renal function[20]. 20% of AKI patients require renal replacement therapy (RRT) approximately[21]. Although survival rates have improved over the past two decades even though the dialysis rate requiring AKI has increased[22], many problems still remain in the optimal administration of RRT for AKI. Apart from the therapy mode, treatment dose and type of anticoagulation, the initiation timing of treatment is considered an important determinant of the outcome of critically ill patients receiving RRT[23]. The KDIGO AKI guideline is widely accepted and recommend the initiation RRT without delay in case of lifethreatening complications[24]. Until recently, only few small RCTs and some observational and cohort studies examining timing of initiation of RRT, some of which showed beneficial effects of “early” RRT [25]. However, there has been no clear consensus on how to define “timing” relative to the initiation of RRT in AKI, different definitions of “early” and “late” initial timing of RRT might have biased the results. Basis of definitions in published studies include urine output, creatinine, urea, time from AKI development and hospital or ICU admission[26,27]. In addition, the terms “early” and “late” are relative and what may represent early RRT in one case could be late in another[28]. In our study, we defined “early” and “late” based on urine output, which were defined as “early” when UO during the 24h prior to CRRT was >0.05 mL/kg/h and as “late” when UO was <0.05 mL/kg/h[11]. Timing based on urine output seems to be a more physiological than hospital or ICU admission. Recently, several systematic review and meta-analyses exploring initiation timing of and outcome have been published. The study by Zou et al.[29]strongly supported early initiation, based on the outcomes of 28-day mortality, ICU length of stay, and hospital length of stay. However, there was no difference in survival, ICU or hospital length of stay between early and late RRT in the studies of Bhatt and Wierstra [26,30]. There are a few studies on the application of RRT in post-LT AKI, but no studies on the prognosis of the initiation timing. According to our study, late initiation of RRT can prolong ICU and hospital length of stay, and also increase the risk of infection.

This paper had several limitations. This was a retrospective, single-center study with a small number of patients and the short period of time. Thus, there is clearly a requirement for a prospective large scale trial to further understand RRT for LT-associated AKI in the future.

In conclusion, AKI is a frequent complication of liver transplantation, which is associated with higher mortality and longer ICU and hospital stay. The more intraoperative bleeding volume and Plasma transfusion are risk factors of post-LT AKI. late initiation of RRT can prolong ICU and hospital length of stay, and also increase the risk of infection.

AKI: Acute kidney injury; RRT: renal replacement therapy; PNF: primary nonfunction; EAD: early allograft dysfunction; ICU: intensive care unit; LT: liver transplantation; MELD: Model for end-stage liver disease; DM: diabetes mellitus; BMI: body mass index; DCD: donation after cardiac death; DBD: donation after brain death; HBV: Hepatitis B Virus; UO: urine output; HCC: Hepatocellular carcinoma; sCr: Serum Creatinine.

Acknowledgements

The authors have no acknowledgements.

Author contributions

RA designed the study, RA, LZQ and ZXZ conducted the search and the statistical analysis. MY and DRH assessed the study eligibility and quality and interpreted the data. All authors contributed to the manuscript and approved the final version to be considered for publication.

Funding

This work was supported by grants from the National Natural Science Foundation of China, China (81873591, and 81670591), Guangdong Natural Science Foundation, China (2016A030311028), The Science and Technology Planning Project of Guangdong Province, China (2018A050506030), and Science and Technology Program of Guangzhou, China (201704020073)..

Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.

Ethics approval and consent to participate

The study was approved by the Ethics Committee of The First Affiliated Hospital of Sun Yat-sen University and in accordance with the Declaration of Istanbul. All protocols conformed to the ethical guidelines of the 1975 Helsinki Declaration. All patients gave their written written informed consent prior to inclusion.

Consent for publication

Not applicable.

Competing interests

The authors declare no conflicts of interest. Results presented in this paper have not been published previously in whole or part.

Thongprayoon C, Kaewput W, Thamcharoen N, Bathini T, Watthanasuntorn K, Lertjitbanjong P, et al. Incidence and Impact of Acute Kidney Injury after Liver Transplantation: A Meta-Analysis. J Clin Med. 2019;8(3):372.
Hussaini, T., Yoshida, E. M., Partovi, N., Erb, S. R., Scudamore, C., & Chung, S., et al. Early Persistent Progressive Acute Kidney Injury and Graft Failure Post Liver Transplantation. Transplant Direct. 2019;5(3):e429.
Hilmi, I. A., Damian, D., Al-Khafaji, A., Planinsic, R., Boucek, C., & Sakai, T., et al. Acute kidney injury following orthotopic liver transplantation: incidence, risk factors, and effects on patient and graft outcomes. British Journal of Anaesthesia. 2015;114(6):919–926.
De Haan, Jubi E, Hoorn, Ewout J, de Geus, Hilde R. H. Acute kidney injury after liver transplantation: Recent insights and future perspectives. Best Pract Res Clin Gastroenterol. 2017; 31(2):161–169.
Rahman S, Mallett S V, Davidson B R. Early acute kidney injury after liver transplantation: Predisposing factors and clinical implications. World Journal of Hepatology. 2017;(18):34–43.
Rinaldo Bellomo, Claudio Ronco, John A Kellum, Ravindra L Mehta, Paul Palevsky, the ADQI workgroup. Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Critical Care. 2004; 8(4):R204.
Joannidis, M., Metnitz, B., Bauer, P., Schusterschitz, N., Moreno, R., & Druml, W., et al. Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med. 2009;35:1692e702.
Work Group Membership. Kidney Int Suppl (2011) 2012;2:2.
Romagnoli, S., Clark, W. R., Ricci, Z., & Ronco, C. Renal Replacement Therapy for AKI: When? How much? When to Stop?. Best Practice & Research Clinical Anaesthesiology. 2017;31(3):371–385.
Pickkers, P., Ostermann, M., Joannidis, M., Zarbock, A., Hoste, E., & Bellomo, R., et al. The intensive care medicine agenda on acute kidney injury. Intensive Care Medicine. 2017; 43(9):1–12.
Pérez-Fernández, Xosé, Sabater-Riera, J., Sileanu, F. E., Vázquez-Reverón, José, Ballús-Noguera, Josep, & Cárdenas-Campos, Paola, et al. Clinical variables associated with poor outcome from sepsis-associated acute kidney injury and the relationship with timing of initiation of renal replacement therapy. J Crit Care. 2017;40:154–60.
Kim WH, Lee HC, Lim L, Ryu HG, Jung CW. Intraoperative Oliguria with Decreased SvO Predicts Acute Kidney Injury after Living Donor Liver Transplantation. J. Clin. Med. 2018; 8: 29.
Jochmans, I., Meurisse, N., Neirynck, A., Verhaegen, M., Monbaliu, D., & Pirenne, J, et al. Hepatic ischemia-reperfusion injury associates with acute kidney injury in liver transplantation: Prospective cohort study. Liver Transplantation. 2017; 23(5):634–644.
Joanna, B. S., Judith, S., Miller, E. J., Berlakovich, G. A., Baron, D. M., & Peter, F., et al. Comparison of macrophage migration inhibitory factor and neutrophil gelatinase-associated lipocalin–2 to predict acute kidney injury after liver transplantation: An observational pilot study. PLOS ONE. 2017; 12(8):e0183162-.
De Ataide EC, Perales SR, Bortoto JB, Peres MAO, Filho FC, Stucchi RSB, et al. Immunomodulation, Acute Renal Failure, and Complications of Basiliximab Use After Liver Transplantation:Analysis of 114 Patients and Literature Review. Transplant. Proc. 2017；49： 852–857.
Leithead, J. A., Rajoriya, N., Gunson, B. K., Muiesan, P., & Ferguson, J. W. The evolving use of higher risk grafts is associated with an increased incidence of acute kidney injury after liver transplantation. Journal of Hepatology.2014; 60(6):1180–1186.
Pham PTT, Pham PCT, Wilkinson AH. Management of renal dysfunction in the liver transplant recipient. Curr Opin Organ Transplant. 2009; 14: 231–9.
Lewandowska L, Matuszkiewicz-Rowińska J, Jayakumar C, Oldakowska-Jedynak U, Looney S, Galas M,et al.Netrin–1 and Semaphorin 3A Predict the Development of Acute Kidney Injury in Liver Transplant Patients. PLOS ONE.2014; 9(10): e107898.
Carmona, M., álvarez, Marina, Marco, J., Mahíllo, Beatriz, Domínguez-Gil, Beatriz, & Nú?ez, José Ramón, et al. Global Organ Transplant Activities in 2015. Data from the Global Observatory on Donation and Transplantation (GODT). Transplantation. 2017; 101:S29.
Lins, R. L. RRT treatment for AKI: is more always better?. Nephrology Dialysis Transplantation. 2012; 27(12):4252–4255.
Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational Aki-epi study. Intensive Care Med. 2015;41(8):1411–23.
Wald R, McArthur E, Adhikari NK, Bagshaw SM, Burns KE, Garg AX, et al. Changing incidence and outcomes following dialysis-requiring acute kidney inury among critically ill adults: a population-based cohort study. Am J Kidney Dis. 2015;65:870–7.
Vinsonneau C, Allain-Launay E, Blayau C, Darmon M, Ducheyron D, Gaillot T, et al. Renal replacement therapy in adult and pediatric intensive care. Annals of Intensive Care. 2015; 5(1):58.
Palevsky, P.M., Liu, K. D., Brophy, P. D., Chawla, L. S., Parikh, C. R., & Thakar, C. V., et al. KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for Acute Kidney Injury. American Journal of Kidney Diseases the Official Journal of the National Kidney Foundation. 2013; 61(5):649–672.
Meersch, M., Küllmar, Mira, Schmidt, C., Gerss, J., Weinhage, T., & Margraf, A., et al. Long-Term Clinical Outcomes after Early Initiation of RRT in Critically Ill Patients with AKI. Journal of the American Society of Nephrology. 2017; 29(3):1011–1019.
Wierstra, B. T., Sameer, K., Soha, A., Ximena, B., Barrisford, G. W., & Kao, R. L. C. The impact of " early” versus " late " initiation of renal replacement therapy in critical care patients with acute kidney injury: a systematic review and evidence synthesis. Crit Care. 2016;20:122.
Liu, Y., Davari-Farid, S., Arora, P., Porhomayon, J., & Nader, N. D. Early Versus Late Initiation of Renal Replacement Therapy in Critically Ill Patients With Acute Kidney Injury After Cardiac Surgery: A Systematic Review and Meta-analysis. J Cardiothorac Vasc Anesth.2014;28(3):557–63.
Romagnoli S, Ricci Z. When to start a renal replacement therapy in acute kidney injury patients (AKI): many irons in the fire. Ann Transl Med. 2016;4(18):355.
Zou H, Hong Q, Xu G. Early versus late initiation of renal replacement therapy impacts mortality in patients with acute kidney injury post cardiac surgery: a meta-analysis. Crit Care. 2017;21:150
Bhatt GC, Das RR. Early versus late initiation of renal replacement therapy in patients with acute kidney injury-a systematic review & meta- analysis of randomized controlled trials. BMC Nephrol. 2017;18(1):78.

Table 1 Staging of AKI

Stage	Serum creatinine	Urine output
I	Increase in SCr 1.5-1.9 times baseline within prior 7 day or ≥0.3 mg dL^-1 within 48 hours	<0.5 mL kg ^-1 h ^-1for 6-12 h
II	Increase in SCr 2.0-2.9 times baseline	<0.5 mL kg^-1 h^-1 for ≥12 h
III	Increase in SCr 3.0 times baseline or Increase in SCr ≥4.0 mg dL ^-1 or Initiation of renal replacement therapy or In patients <18 years, decrease in eGFR to <35 mL min^-1 per 1.73 m²	<0.3 mL kg^-1h^-1for ≥24 h or anuria for ≥12 h

From 2012 Kidney Diseases Improving Global Outcomes (KDIGO) Clinical Practice Guideline(8).

Table 2 Descriptions of variables and univariate results

	AKI (n = 48)	Non-AKI (n = 125)	P-value
Preoperative variables
Age ,mean (SD), year	51.69(9.53)	50.32(10.23)	0.424
Male, n(%)	43（89.58）	115（92）	0.563
BMI，mean (SD)	23.23（2.24）	22.18（2.46）	0.269
HBV, n(%)	38（79.17）	111（88.8）	0.139
MELD Score, median (IR)	18(11.25-25.75)	12.5(9-19.25)	0.239
Etiologic factors			0.291
HCC, n(%)	22（45.83）	70（56）
Hepatitis B cirrhosis, n(%)	10（20.83）	30（24）
Alcoholic cirrhosis, n(%)	4（8.33）	3（2.4）
hepatic failure, n(%)	11（22.92）	18（14.4）
Other, n(%)	1（2.08）	4（3.2）
Diabetes, n(%)	5（10.42）	9（7.2）	0.537
Hypertension, n(%)	3（6.25）	4（3.2）	0.398
hepatic encephalopathy, n(%)	4（8.33）	1（0.8）	0.021
Donor graft
Age ,mean (SD), year	41（32.75-47.75）	38（24-46）	0.03
Male, n(%)	40（83.33）	88（70.4）	0.121
DCD, n(%)	48（100）	124（99.2）	0.723
DBD, n(%)	0（0）	1（0.8）
Total bilirubin, median (IR), μmol/L	18.9（12.35-34）	22.8（13.25-33.75）	0.921
Na⁺ , median (IR), mmol L ^-1	148（140.5-158）	148（141.75-156）	0.969
Cold ischemia time, median (IR), min	415（352.5-477.75）	323（67.5-388.5）	0.217
Steatosis in donor liver			0.144
0, n(%)	29（60.42）	85（68）
1, n(%)	16（33.33）	33（26.4）
2, n(%)	3（6.25）	2（1.6）
3, n(%)	0（0）	5（4）
Intraoperative
Operation time, median (IR), min	442.5（393-505.25）	323（67.5-388.5）	0.217
Piggyback, n (%)	30（62.5）	72（57.6）	0.341
Normothermic mechanical perfusion, n (%)	8（16.67）	32（25.6）	0.147
Anhepatic phase, median (IR), min	52（41.5-65）	49（40-59）	0.446
Blood loss, median (IR), mL	2500（1950-5175）	1500（800-2500）	0.000
RBC transfusion, median (IR), unit	7.5（3.75-12）	4（2-7）	0.000
Plasma transfusion , median (IR), mL	1750（1200-2575）	1400（1000-1950）	0.000
Cryoprecipitate transfusion, median (IR), unit	0（0-0）	0（0-0）	0.022
Platelet transfusion, median (IR), unit	1（0-1）	0（0-1）	0.023

Table 3 Independent Predictors of AKI after liver transplantation Based on Multivariate logistic regression

	OR (95% CI)	P
Anhepatic phase	1.007（0.984-1.030）	0.563
Cold ischemia time	1.002（1.000-1.004）	0.097
Hepatic encephalopathy,	0.160（0.012-2.187）	0.170
Operation time	0.996（0.990-1.001）	0.137
Blood loss	1.000（1.000-1.001）	0.001
RBC transfusion	1.000（0.999-1.000）	0.339
Plasma transfusion	1.000（1.000-1.001）	0.032
Cryoprecipitate transfusion	0.994（0.930-1.064）	0.869

Table 4 Comparison of clinical outcomes Between AKI group and Non-AKI group

	AKI(n=48)	Non-AKI (n = 125)	P-value
Length of ICU stay, median (IR), h	85（21.5-196.5）	28.6（15-42）	0.000
Length of hospital stay, median (IR), day	24.5（17-40）	20（15-29）	0.003
30 day mortality, n (%)	10(20.83)	2(1.6)	0.000
90 day mortality, n (%)	13(27.08)	2(1.6)	0.000
PNF, n (%)	8(16.67)	0(0)	0.000
EAD, n (%)	25(52.08)	27(21.6)	0.000
Acute rejection, n (%)	1(2.08)	10(8)	0.138

Table 5 Comparison of clinical outcomes Between Early group and Late group

	Early(13)	Late(10)	P-value
Length of ICU stay, median (IR), h	139(94-240)	183.5(92.25-336.75)	0.043
Length of hospital stay, median (IR), day	35(17-38)	38.5(17.5-62.75)	0.019
30 day mortality, n (%)	3(23.08)	4(40)	0.337
90 day mortality, n (%)	4(30.76)	5(50)	0.306
PNF, n (%)	1(7.69)	4(40)	0.089
EAD, n (%)	9(69.23)	8(80)	0.463
Severe infection, n (%)	4(30.76)	8(80)	0.026

Download PDF

Version 1

posted

You are reading this latest preprint version

Impact of Early versus Late Initiation of Renal Replacement Therapy in Patients with acute kidney injury after liver transplantation: a retrospective study.

Status:

Version 1

Abstract

Background

Methods

Results

Discussion

Abbreviations

Declarations

Acknowledgements

Author contributions

Funding

Availability of data and materials

Ethics approval and consent to participate

Consent for publication

Competing interests

Reference

Tables

Status:

Version 1